Susceptibility to first choice antimicrobial treatment for urinary tract infections to Escherichia coli isolates from women urine samples in community South Brazil

ABSTRACT E. coli is the main pathogen of UTI. It is important to be aware the local epidemiological data for an appropriate initial treatment. Resistance to antimicrobial agents has increased, especially to first-choice antibiotics in the treatment of cystitis. There are few studies on the sensivity profile of community uropathogen in our region. Objective: To characterize antimicrobials the sensitivity profile to E. coli isolated from urocultures of women treated at Basic Health Units and Emergency Care Units of Londrina-Paraná- Brazil during a period of 12 months (June 1, 2016 to June 1, 2017). Methodology: A cross-sectional study was carried out from June 2016 to June 2017. All urine samples collected in the Basic Health Units and Emergency Departments in the city of Londrina (Paraná State, Brazil) were sent to a Central Laboratory where the identification and antimicrobial susceptibility testing were performed. Clinical Laboratory Standards Institute (CLSI) breakpoints were used for the interpretation of susceptibility testing results. Results: 56,555 urine cultures were performed in the period, of which 8,832 were positive, of which 5,377 were women. Of these samples, 4.7% were enterobacteria producing extended-spectrum beta-lactamases (ESBL) and 15.5% resistant to quinolones. TMP- SMX was resistant in more than 30% of the samples in all age groups. Among quinolone-resistant isolates, resistance to cephalothin, ampicillin and sulfamethoxazole-trimethoprim was greater than 60%. Nitrofurantoin was the only antimicrobial that showed 90% of sensitivity. Conclusion: The antimicrobials sensitivity profile was similar to that reported in the literature, with TMP- SMX resistance greater than 30% in the studied samples. Nitrofurantoin maintains high sensitivity rates greater than 90%. Resistance to quinolones increases proportionally with age, as well ESBL.

Prevalence of enteroparasitosis in children in a city in the north of Paraná and the associated factors / Prevalência de enteroparasitoses em crianças de uma cidade do norte do Paraná e fatores associados

The objective of this study was to investigate the prevalence of enteroparasitosis and the factors involved in their transmission in children between the ages of 0 and 15 in the city of São Jerônimo da Serra, Paraná. The study was carried out from July 2014 to June 2017. 362 samples were analyzed using the methods of Hoffman, Pons and Janer, Faust and collaborators, and Kato-Katz modified. Associations between the socioeconomic variables, as it relates to the habits and environment of the children, and enteroparasitosis were verified by logistic regression, considering a level of significance of 5%. We encountered a high prevalence of enteroparasites (36.5%), a high frequency of polyparasitism (43.9%) and a higher frequency of protozoa (34.5%) in relation to helminths (3.9%). The pathogenic parasites found were Giardia lamblia (8.0%), Entamoeba histolytica/dispar (3.6%), Hymenolepis nana (2.5%), Enterobius vermicularis (2.2%), Ascaris lumbricoides (1.1%), hookworms (0.8%) and Trichuris trichiura (0.3%). Endolimax nana was the most frequent (19.3%); even though it is a commensal amoeba, its detection is concerning since the transmission mechanism (fecal-oral) is equal to pathogenic microorganisms. We observed an association between the presence of enteroparasitosis and age group, household income, education level of parents/guardians, living in rural area, consumption of untreated water, inadequate garbage disposal, contact with sand or dirt and presence of a household pet. Hygienic habits, sanitary, socioeconomic and socio-demographic conditions are directly related to infection by intestinal parasites and must be improved to avoid dissemination in the population (AU)

O objetivo deste estudo foi investigar a prevalência de enteroparasitoses e os fatores envolvidos na transmissão de enteroparasitoses em crianças de 0 a 15 anos de idade do município de São Jerônimo da Serra, Paraná. O trabalho foi desenvolvido no período de julho de 2014 a junho 2017. Analisou-se 362 amostras pelos métodos de Hoffman, Pons e Janer e Faust e cols. As associações entre variáveis socioeconômicas, referentes aos hábitos das crianças e ao ambiente em que vivem e enteroparasitoses foram verificadas por meio de regressão logística, considerado nível de significância de 5%. Encontrou-se alta prevalência de parasitismo (36,5%), uma alta frequência de poliparasitismo (43,9%) e uma freqüência maior de protozoários (34,5%) em relação aos helmintos (3,9%). Os enteroparasitas patogênicos encontrados foram Giardia lamblia (8,0%), Entamoeba histolytica/dispar (3,6%), Hymenolepis nana (2,5%), Enterobius vermicularis (2,2%), Ascaris lumbricoides (1,1%), ancilostomídeos (0,8%) e Trichuris trichiura (0,3%). Endolimax nana foi o mais frequentemente encontrado (19,3%). Mesmo sendo comensal, sua detecção é preocupante uma vez que o mecanismo de transmissão (fecal-oral) é igual dos microrganismos patogênicos. Observou-se associação entre a presença de enteroparasitoses e faixa etária, renda familiar, escolaridade dos responsáveis, morar em zona rural, consumo de água não tratada, destino inadequado do lixo, contato com areia ou terra e presença de um animal de estimação Hábitos de higiene, condições sanitárias, socioeconômicas e sociodemográficas estão diretamenterelacionados às infecções por parasitos intestinais e devem ser melhoradas para evitar disseminação na população(AU)

Temporal and spatial distribution of American tegumentary leishmaniasis in north Paraná: 2010-2015

Abstract INTRODUCTION: Describing the general aspects of American tegumentary leishmaniasis enables the identification of the epidemiological scenario of the disease and the development of preventive actions. METHODS: We analyzed the records of patients with American tegumentary leishmaniasis in north Paraná between 2010 and 2015. RESULTS: We identified 108 cases (mostly in 2014) with the following characteristics: male individuals, rural workers, and ages averaging 56.8 years. Isolated ulcerated lesions were predominant, and Glucantime® was the most frequently used drug. CONCLUSIONS: American tegumentary leishmaniasis remains endemic and affects mostly men found in areas surrounded by woods; its treatment is partially efficient considering its side effects and incidence of recurrences.

Perfil clínico de pacientes com diagnóstico de tuberculose atendidos no Hospital Universitário de Londrina, Paraná / Clinical profile of patients diagnosed with tuberculosis treated at the University Hospital of Londrina, Paraná

O objetivo deste estudo consistiu em analisar o perfil clínico de pacientes positivos para tuberculose através de um estudo epidemiológico, descritivo e retrospectivo, com base em dados secundários contidos em prontuários dos pacientes atendidos no Hospital Universitário de Londrina compreendendo de janeiro de 2010 a dezembro de 2014. Dos prontuários disponíveis para a análise no momento de estudo 86 casos eram positivos para tuberculose, sendo a maioria do sexo masculino (65/76%) com faixa etária compreendida entre 2 e 91 anos. Os principais sinais clínicos apresentados foram tosse (50/58%), febre (45/52%) e perda de peso (34/40%). Em relação à forma clinica, 58/67% dos pacientes apresentaram a forma pulmonar, e 28/33% a forma não pulmonar. Casos positivos para tuberculose em associação com HIV/AIDS corresponderam a 32/37%. Também foram relatados hábitos prejudiciais dos pacientes nos quais 30/34% eram tabagistas, 20/23% usuários de drogas e 14/16% etilistas. Diante da escassez de dados publicados referentes à tuberculose na nossa região e sua relevância para a saúde pública, nosso estudo contribui com os aspectos epidemiológicos principalmente em relação ao elevado número de casos de coinfecção com Vírus da Imunodeficiência Humana e pacientes com evolução a óbito, auxiliando assim, o desenvolvimento e implementação de campanhas ou projetos que visem o diagnóstico e tratamento precoce.

The objective of this study was to analyze the clinical profile of patients positive for tuberculosis through an epidemiological study, descriptive and retrospective, based on secondary data contained in medical records of patients that attended the Hospital Universitário de Londrina comprising from January 2010 to December 2014. From the medical records available for analysis at the moment of study 86 cases were positive for tuberculosis, being the majority male (65/76%) with age group comprised between 2 to 91 years. The main symptoms presented were cough (50/58%), fever (45/52%) and weight loss (34/40%). Regarding the clinical form, 58/67% of the patients presented the pulmonary form, and 28/33% the non-pulmonary form. Positive cases for tuberculosis in association with HIV/AIDS corresponded to 32/37%. Harmful habits were also reported in patients in which 30/34% were smokers, 20/23% drug users and 14/16% were alcoholics. Against scarcity of published data referring to tuberculosis in our region and its relevance to public health, our study contributes to the epidemiological aspects mainly in relation to the high number of cases of coinfection with Human Immunodeficiency Virus and patients with evolution to death, assisting the development and implementation of campaigns or projects aimed at early diagnosis and treatment.

Sodium nitroprusside has leishmanicidal activity independent of iNOS

Abstract: INTRODUCTION: Leishmaniasis is a zoonotic disease caused by protozoa of the genus Leishmania . Cutaneous leishmaniasis is the most common form, with millions of new cases worldwide each year. Treatments are ineffective due to the toxicity of existing drugs and the resistance acquired by certain strains of the parasite. METHODS: We evaluated the activity of sodium nitroprusside in macrophages infected with Leishmania (Leishmania) amazonensis . Phagocytic and microbicidal activity were evaluated by phagocytosis assay and promastigote recovery, respectively, while cytokine production and nitrite levels were determined by ELISA and by the Griess method. Levels of iNOS and 3-nitrotyrosine were measured by immunocytochemistry. RESULTS: Sodium nitroprusside exhibited in vitro antileishmanial activity at both concentrations tested, reducing the number of amastigotes and recovered promastigotes in macrophages infected with L. amazonensis . At 1.5µg/mL, sodium nitroprusside stimulated levels of TNF-α and nitric oxide, but not IFN-γ. The compound also increased levels of 3-nitrotyrosine, but not expression of iNOS, suggesting that the drug acts as an exogenous source of nitric oxide. CONCLUSIONS: Sodium nitroprusside enhances microbicidal activity in Leishmania -infected macrophages by boosting nitric oxide and 3-nitrotyrosine.

Leishmanicidal activity of brazilian propolis hydroalcoholic extract in Leishmania amazonensis / Atividade leishmanicida de extrato hidroalcoólico de própolisbrasileira em Leishmania amazonensis

As leishmanioses são consideradas doenças negligenciadas devido às altas incidências, ampla distribuição geográfica e dificuldade no tratamento sendo incluídas na relação de doenças prioritárias pela Organização Mundial da Saúde. Os tratamentos disponíveis para estas doenças apresentam elevada toxicidade,justificando a busca por fármacos alternativos. Estudos prévios com própolis, resina produzida por abelhas,demonstraram sua atividade antiparasitária e imunomoduladora em diversos modelos experimentais. O objetivo deste trabalho foi avaliar o efeito in vitro do extrato hidroalcoólico de própolis brasileira, coletadona cidade de Botucatu no estado de São Paulo, sobre formas promastigotas de Leishmania amazonensis, bem como analisar seu efeito in vivo sobre a carga parasitária em baço de camundongos susceptíveis à infecção. Assim, formas promastigotas tratadas com extrato hidroalcoólico de própolis brasileira nas concentrações 5, 10, 25, 50 ou 100 µg/mL apresentaram efeito inibitório sobre a proliferação desses parasitos nos tempos de 24, 96 e 168 h. No entanto, as concentrações de 50 e 100 µg/mL mostraram-se mais eficazes quando comparadas ao controle e às demais concentrações em todos os tempos avaliados.Em relação à carga parasitária, após 30 dias de infecção com L. amazonensis, camundongos BALB/c foram tratados diariamente com a própolis (5mg/kg), via oral ou intraperitoneal, durante 60 dias. Posteriormente,o baço destes animais foi coletado para análise da carga parasitária. O tratamento por via oral reduziu 40%da carga parasitária. Desta forma, a amostra de própolis brasileira testada apresentou ação leishmanicida sobre L. amazonensis em cultura e em camundongos infectados com este protozoário.

Leishmaniosis are considered neglected diseases due to its high incidence, widespread and difficultyin treatment being included in the list of priority diseases by the World Health Organization. Available treatments for these diseases have high toxicity, which explains the search for more effective drugs. Previous studies with propolis - a resinous substance produced by bees - demonstrated immunomodulatory and anti-parasitic activity in several experimental models. The objective of this study was to evaluatethe effect in vitro of Brazilian propolis hydroalcoholic extract, collected in the city of Botucatu in SãoPaulo State, on promastigotes forms of Leishmania amazonensis as well as its effect on the parasiteload in the spleen of infected mice. Thus, promastigote forms treated with 5, 10, 25, 50 or 100 μg/mLof Brazilian propolis hydroalcoholic extract at 24, 96 and 168 hours showed inhibitory effect on the spread of these pararasite at all indicated times. However, the concentrations of 50 and 100 μg/mL were more effective, reducing the parasite spread when compared to the control and other concentrations at all times. Regarding parasitic load, after 30 days of infection with L. amazonensis, BALB/c mice were treated on a daily basis with propolis (5mg/kg) orally or intraperitoneally for 60 days. Further, the spleen was collected for parasite load analysis. Oral treatment reduced 40% of the parasitic load. Thus, the tested Brazilian propolis sample showed antileishmanial activity on L. amazonensis in culture andin parasite- infected mice.

Coproparasitological survey of intestinal parasites in the city of Londrina, Parana, Brazil: a retrospective analysis

Intestinal parasites are a major public health problem. It is important to inform and educate the public about these infections, especially where such data are scarce. This study aimed to determine the prevalence of intestinal parasites from the analysis of medical records of individuals of the city of Londrina. We analyzed 11,641 fecal reports from February 2009 to December 2012. Data were cataloged after the completion of parasitological testing of Hoffmann, Pons & Janer, Faust and Kato-Katz. From 11,641 reports, 19.1% were positive for intestinal parasites. Among those, 52.1% pertained to females and 47.9% to males, with predominance of positivity of 27.1% among children 0-10 years. For the regions studied, the northern region stood out with 35.4% of cases and prevalence of 6.8%. Among the pathogenic protozoa, reports of Giardia lamblia comprised 19.1% of positivity, while hookworms were the most frequent among helminths, comprising 7.8% of positive cases. It follows that poor conditions of basic sanitation contribute to the dissemination of these parasites. Early diagnosis is a determinant of successful treatment. Additionally, epidemiological data may be used to study the risk factors for transmission and may result in measures applicable to improving living conditions in the community

Hyperreactive malarious splenomegaly and aids: a case report

Malaria is endemic in the North of Brazil. However, Hyperreactive Malarious Splenomegaly (HMS) has been rarely described. Splenomegaly in HIV/Aids infection has a large differential diagnosis, but malaria is a cause of gross splenomegaly, regardless of the HIV status. In this paper, we report the case of a 50-year-old man, HIV positive, with massive splenomegaly and multiple malaria infections in the past. He fulfilled the criteria for HMS, received a short course of anti-malarial treatment and weekly quimioprofilatic Chloroquine. In 9 months, he had great clinical and laboratorial improvement confirming the HMS, a rare diagnosis in Brazil.

The effects of nitric oxide on the immune response during giardiasis

Nitric oxide (NO) is a free radical synthesized from L-arginine by different isoforms NO-synthases. NO possesses multiple and complex biological functions. NO is an important mediator of homeostasis, and changes in its generation or actions can contribute or not to pathological states. The knowledge of effects of NO has been not only important to our understanding of immune response, but also to new tools for research and treatment of various diseases. Knowing the importance of NO as inflammatory mediator in diverse infectious diseases, we decided to develop a revision that shows the participation/effect of this mediator in immune response induced against Giardia spp. Several studies already demonstrated the participation of NO with microbicidal and microbiostatic activity in giardiasis. On the other hand, some works report that Giardia spp. inhibit NO production by consuming the intermediate metabolite arginine. In fact, studies in vitro showed that G. lamblia infection of human intestinal epithelial cells had reduced NO production. This occurs due to limited offer of the crucial substrate arginine (essential aminoacid for NO production), consequently reducing NO production. Therefore, the balance between giardial arginine consumption and epithelial NO production could contribute to the variability of the duration and severity of infections by this ubiquitous parasite.

High molecular mass fraction in clinical isolates of Paracoccidioides brasiliensis / Fração de alta massa molecular em isolados clínicos de Paracoccidioides brasiliensis

INTRODUCTION: Different serum levels of the IgG/IgE for Paracoccidioides brasiliensis high mass molecular (hMM) fraction (~366kDa) in the acute and chronic forms of the disease have been reported. Considering the nonexistence of hMM fraction investigation involving clinical isolates of P. brasiliensis, the present study aimed to investigate the presence of the hMM fraction (~366kDa) in cell free antigens (CFA) from P. brasiliensis clinical isolates. METHODS: CFA from 10 clinical isolates and a reference strain (Pb18) were submitted to SDS-polyacrylamide gel electrophoresis (SDS-PAGE) followed by gel image capturing and densitometer analysis. Additionally, CFA from 20 isolates and Pb18 were analyzed by capture ELISA (cELISA) using polyclonal (polAb) or monoclonal (mAb) antibodies to the hMM fraction. RESULTS: The presence of the hMM component was observed in CFA of all samples analyzed by SDS-PAGE/densitometry and by cELISA. In addition, Pearson's correlation test demonstrated stronger coefficients between hMM fraction levels using pAb and mAb (R = 0.853) in cELISA. CONCLUSIONS: The soluble hMM fraction was present in all the P. brasiliensis clinical isolates analyzed and the reference strain Pb18, which could be used as a source of this antigen. The work also introduces for first time, the cELISA method for P. brasiliensis hMM fraction detection. Analysis also suggests that detection is viable using polAb or mAb and this methodology may be useful for future investigation of the soluble hMM fraction (~366kDa) in sera from PCM patients.

INTRODUÇÃO: Diferentes níveis sorológicos de IgG/IgE contra a fração de alta massa molecular (hMM) (~366kDa) de Paracoccidioides brasiliensis têm sido encontrados na PCM aguda e crônica. Considerando a inexistência de investigação sobre esta fração em isolados clínicos de P. brasiliensis, o objetivo deste estudo foi investigar a presença da fração hMM (~366kDa) no preparado livre de células (CFA) de P. brasiliensis obtidos de isolados clínicos. MÉTODOS: CFA de 10 isolados e de cepa de referência (Pb18) foram submetidas à eletroforese em gel de SDS-poliacrilamida (SDS-PAGE) seguida de captura de imagem e análise por densitometria. Adicionalmente, CFA de 20 isolados e de Pb18 foram analisados por ELISA captura (cELISA) utilizando anticorpos policlonal (polAb) ou monoclonal (mAb) para fração hMM. RESULTADOS: A presença do componente de hMM foi observada em todas as amostras analisadas por SDS-PAGE/densitometria e por cELISA. Adicionalmente, o teste de correlação de Pearson demonstrou forte relação entre os níveis de fração hMM usando pAb e mAb (R = 0.853) no cELISA. CONCLUSÕES: Conclui-se que a fração hMM está presente em todos os isolados clínicos de P. brasiliensis analisados e no isolado referencial, sugerindo a possibilidade dos mesmos serem utilizados como fonte desta fração antigênica. Este trabalho também introduz pela primeira vez o método de cELISA para detecção da fração hMM de P. brasiliensis, sugerindo que detecção utilizando anticorpos polAb ou mAb é viável e essa metodologia poderá ser útil para investigação futura desta fração solúvel (~366kDa) em soros de pacientes com PCM.